The first menstrual period (menarche) occurs around the age of 12 – 13 and ceases with menopause, around the age of 50.
Although women can conceive on any day of their menstrual cycle, fertility is at its peak two days before and two days after ovulation. This “fertility window” varies among women, and from cycle to cycle in the same woman.
An egg may be fertilized up to 2 days after ovulation. Spermatozoa survive for 2 – 3 days in the women’s reproductive system, with a maximum of 5 days.
These parameters are important and should be taken into account by couples whose means of contraception is based on the calendar method.
A woman’s likelihood of conceiving is based primarily on age and is as follows:
As a general rule, it is recommended that a couple consult a Fertility Specialist if they have been trying to conceive for a year with no success. They should seek medical advice earlier if there is a history of miscarriages, gynecological surgery or woman’s age over 35 years.
The advanced age in men is associated with decreased semen volume, lower sperm density (oligospermia), reduced motility (asthenospermia) and abnormal morphology (teratozoospermia).
• In males 20 – 39 years old, 90 % of the seminiferous tubules contain mature sperm
• In males 40 – 69 years old, 50 % of the seminiferous tubules contain mature sperm
• In males ≥ 80, 10 % of the seminiferous tubules contain mature sperm
Excess body fat, in addition to other harmful effects, can lead to the overproduction of certain hormones that disrupt ovulation. Obesity may cause the cycle to be irregular and to not ovulate as often, reducing the chances of pregnancy.
Similarly, extremely low weight (body mass index BMI < 17) often means that the body cannot produce enough hormones to produce oocytes or maintain a pregnancy. Exercise, without extremes, can help maintain a healthy weight. Women who exercise intensely (eg long distance runners) may stop producing oocytes or ovulate less often.
Excessive exercise also increases the risk of miscarriage. Discuss your exercise regime with your gynaecologist or midwife when trying to get pregnant.
A balanced and complete diet increases the chances of pregnancy. Be sure to include protein, iron, zinc and vitamin C, because deficiency in these nutrients has been associated with prolonged cycles (and therefore less frequent ovulation) and a higher risk of miscarriage.
A balanced diet includes foods rich in protein such as meat, fish, low fat dairy products, eggs and beans. Vegetarians can get essential amino acids by including a variety of delicious protein foods in their diet such as rice, beans and tofu.
The toxins in cigarette smoke are not only harmful to the oocytes, interfering with the process of fertilization and implantation, but also cause ovarian aging. In other words, the ovaries of a 35-year-old smoker may function as if they belong to a 40-year-old woman and are therefore less fertile. Smoking causes permanent damage to fertility but, after smoking cessation, normal ovarian function may be partially restored.
A normal menstrual cycle lasts about 25 to 35 days (counting from the first day of the period).
If the duration is much longer, eg 42 days, ovulation becomes less frequent or does not occur at all, and a visit to the Gynecologist is recommended.
When a woman wishes to conceive, the “fertile window” should be determined during which regular sexual intercourse is recommended.
A woman’s fertile days are usually the day of ovulation and 3-4 days earlier, not later.
The theory, however, that ovulation occurs by default on the 14th day of the cycle is not accurate. Ovulation varies dramatically from woman to woman and may occur as early as Day 6 or as late as Day 21 of the cycle.
How can a woman determine when she will ovulate? She may try using an ovulation kit, which measures certain hormones in the urine, or monitor the daily changes in her body temperature and cervical mucus. Nevertheless, the reliability of these methods is limited, and individualized guidance from a Gynaecologist is recommended.
Anxiety and depression can interfere with fertility. Scientific studies report that women are less likely to conceive when they are psychologically stressed. Stress, like intense exercise, may disrupt hormone production, making the menstrual cycle less predictable.
Proper management of stress through relaxation techniques (such as meditation or yoga) or support from a counselor or a group, can regulate the hormones levels.
Recent studies link alcohol consumption with reduced ability to conceive (in addition to the damage it can cause the embryo and other organs).
Alcohol alters the estrogen levels, which may affect implantation, although an occasional glass of wine with dinner is unlikely to harm fertility.
The consumption of caffeine should also be reduced, while attempting to conceive as well as during pregnancy.
The demands of everyday life can negatively affect a couple’s sexual appetite. Scientific research shows that women who have intercourse at least once a week are more likely to have a predictable cycle and normal ovulation than those who have sporadic sex.
Sex every 36 to 48 hours, a few days before ovulation will increase the chances of getting pregnant.
A douche can destroy the normal protective flora of the vagina, increasing the risk of bacterial vaginosis.
An unpleasant odor and vaginal secretions are often the only indications of infection.
Such infections have been linked to premature birth and may be associated with an increased risk of miscarriage and infertility.
A visit to the doctor is necessary if any symptoms of vaginitis are observed (eg itching, burning sensation, abnormal mucus, ulcers, etc.).
The contraceptive pill can actually enhance fertility. There are indications that temporarily stopping ovulation “rests” the reproductive system and protects the ovaries from aging.
For some women, the pill may be critical for the maintenance of fertility because it keeps endometriosis and uterine fibroids under control. Once birth control pills are stopped, the cycle returns to its previous state in about a month.
Similar factors that affect the fertility of women may affect the reproductive health of men.
Cigarettes, alcohol and a poor diet are all factors that may reduce sperm production or sperm motility.
Studies have also reported chromosomal damage in spermatozoa due to smoking and alcohol.
Anti-oxidants, such as Vitamins E and C, selenium, carnitine, etc., assist in producing healthy sperm. Therefore, the daily intake of a multivitamin is a good first step.
Sperm production takes approximately three months, hence steps should be taken to improve the husband’s reproductive health at least 3 to 6 months prior to attempting to get pregnant.